A Sengstaken-Blakemore tube is a tube used in emergency medicine to stop bleeding in your stomach or esophagus. The technique used to place the tube is called balloon tamponade.
How Does a Sengstaken-Blakemore Tube Work?
The Sengstaken-Blakemore tube is a red tube with three ports on one end and two balloons on the other. One balloon goes into your stomach and is filled with air using one port.
The other balloon sits in your esophagus and is inflated with the second port. The third port, called the gastric suction port, suctions fluid and air out of your stomach.
This tube was invented in the 1950s and hasn’t changed much since then. With the invention of endoscopy, the Sengstaken-Blakemore tube isn’t often used unless other treatments don't work or aren’t available.
An endoscopy is a thin tube with a camera on the end that goes into your esophagus. Your doctor can use it to diagnose a condition and to do procedures like burning a bleeding blood vessel.
Sengstaken-Blakemore Tube vs Minnesota Tube
The Minnesota tube is a variation of the Sengstaken-Blakemore tube. The Minnesota tube has a fourth port that pulls out air and fluid from the esophagus. This helps stop you from breathing fluids into your lungs during this procedure.
Another variation is called the Linton-Nachlas tube, or a nasogastric tube. This version has only one balloon and is inserted through your nose and into your stomach. The nasogastric tube is used for bleeding that’s only in your stomach.
Purpose of a Sengstaken-Blakemore Tube
The Sengstaken-Blakemore tube is used to control bleeding from esophageal and gastric varices. These are veins in your esophagus and stomach lining that swell up when you have blood flow problems.
The most common cause of these varices is liver cirrhosis, or scarring. As scars form, the blood vessels are squeezed and blocked off. This leads to high blood pressure in the vein between your liver and your digestive organs.
The pressure in your stomach and esophagus blood vessels also rises and leads to varices, or swollen veins. This can cause life-threatening bleeding.
Bleeding can also be caused by:
- Sores or ulcers in the lining of your esophagus
- Gastric band erosion, a complication of gastric banding
- A tear in your lower esophagus called a Mallory-Weiss tear
- A tumor
Your doctor will use other methods first to try and stop the bleeding, like medications, injections into the veins, or ligation to tie off a varice. If those don’t work, they will use a Sengstaken-Blakemore tube.
Your doctor might also use this tube in rural settings or hospitals where there aren’t any specialist surgeons.
The tube is a temporary fix because as soon as it is removed the bleeding will start again. Because of this, you might be transferred to a different hospital for special treatment.
There are also times when your doctor won’t do this procedure. These can include:
- Recent surgery on your esophagus or stomach muscles
- Your bleeding stops
- Your esophagus is narrowed
- Your esophagus is blocked
Sengstaken-Blakemore Tube Placement
Before they place the tube, your doctor will give you a local anesthetic, insert a breathing tube, and drain your stomach. A Sengstaken-Blakemore tube is usually inserted through your mouth, although sometimes it can be done through your nose.
Once it’s in your stomach, your doctor will inflate the tube with some air and then take an X-ray scan to make sure it’s in the right place. Once they make sure it's in the correct spot, they’ll inflate it in small amounts.
Once the Sengstaken-Blakemore tube is inflated, they’ll apply a weight to the tube for traction. This makes the tube stretch a little. The inflation combined with the weight puts pressure on the blood vessels and helps stop your bleeding.
They will use the gastric suction port to pull out any fluids and check for blood under the balloon. The esophagus balloon will be inflated in the same way to stop any bleeding in your esophagus.
Once the bleeding is controlled, the balloons will slowly be deflated every three hours until bleeding stays stable with low air in the balloon.
The tube will usually only be in place for 24 hours and your doctor will use other methods to fix the bleeding.
Sengstaken-Blakemore Tube Complications
There are possible complications with Sengstaken-Blakemore tube placement. The most common is aspiration, which happens when you breathe fluids into your lungs. This is why your stomach is drained first.
Other complications can happen, such as:
- Blocked airway
- Esophagus rupture
- Tissue death in your nose, lips, and tongue
- Pressure sores in your esophagus
The Sengstaken-Blakemore tube is used in emergencies to help control bleeding. It is almost always used as a last resort and is considered a life-saving technique.